What pediatric antidepressants are associated with minimal alopecia (hair loss)?

From the Guidelines

Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft) are generally considered to cause less hair loss in pediatric patients compared to other antidepressants. These medications are typically first-line treatments for depression and anxiety in children and adolescents, with starting doses of fluoxetine at 10mg daily or sertraline at 25mg daily, gradually increasing as needed 1.

Key Considerations

• Bupropion (Wellbutrin) should be avoided as it has a higher association with hair loss.
• Hair loss from antidepressants is typically dose-dependent and reversible upon discontinuation or dose reduction.
• The mechanism behind antidepressant-induced hair loss involves pushing hair follicles from the growth phase to the resting phase prematurely.
• If hair loss occurs, it's essential not to stop medication abruptly but to consult with the prescribing physician who may adjust the dose, switch medications, or recommend supportive measures like gentle hair care practices and nutritional supplements containing biotin, zinc, and iron to support hair health 1.

Monitoring and Management

• Regular monitoring and open communication about side effects are essential parts of pediatric antidepressant management.
• Close monitoring for suicidality is recommended by the FDA, especially in the first months of treatment and following dosage adjustments 1.
• Behavioral activation/agitation, mania/hypomania, and serotonin syndrome are potential adverse effects that require careful monitoring and management 1.

From the Research

Pediatric Antidepressants and Alopecia

• There are no direct studies comparing pediatric antidepressants and their association with minimal alopecia (hair loss) 2, 3, 4, 5, 6.
• However, some studies suggest that certain antidepressants may be associated with hair loss in adults, such as fluoxetine 3 and sertraline 6.
• Minoxidil, a medication used to treat hair loss, has been used off-label in pediatric patients, but there are no guidelines for its use in this population 2, 5.
• A consensus statement on the use of low-dose oral minoxidil for patients with hair loss was developed, but it did not establish guidelines for pediatric use 5.
• The available studies do not provide sufficient evidence to determine which pediatric antidepressants are associated with minimal alopecia.

Antidepressants and Hair Loss

• Fluoxetine has been associated with hair loss in a case report of a 30-year-old woman 3.
• Sertraline has also been associated with hair loss in a case report of a woman with a major depressive disorder 6.
• The studies suggest that hair loss may be a rare side effect of certain antidepressants, but more research is needed to fully understand this association.

Pediatric Hair Loss

• Pediatric hair loss is a cause of concern for patients and families, and early diagnosis and treatment are crucial 4.
• The evaluation of hair loss in pediatric patients includes a thorough history, physical examination, and other potential tests 4.
• The causes of hair loss can be classified as either acquired or congenital, and acquired causes can be subdivided into scarring and nonscarring 4.